Aquila Systems AI

Keep an eye on Fraud -- AI-powered fraud detection for workers compensation, healthcare, and government.

Claims Technology Growth Bootstrapped

Overview

Aquila Systems AI is an AI and machine learning-based fraud detection platform purpose-built for insurance, healthcare, and government. The company focuses on workers compensation insurance fraud, provider fraud in healthcare, and benefits fraud in government programs, offering a cloud-based analytics solution with more than 20 pre-built fraud detection use cases. Its platform integrates predictive analytics, link analysis, and IoT-driven signals to identify suspicious patterns before claims are paid, helping carriers, payers, and public agencies reduce losses and lower investigation costs.

The company is a product of SoftSol Technologies Inc. (STI), a US-based technology services firm headquartered in Fremont, California with over 20 years of operating history. Aquila Systems was developed to bring a focused AI fraud analytics product to insurance and government markets. Customers include Employers Insurance Group, where the platform delivered a reported 10X ROI and paid for itself within the first year of deployment. The platform has helped clients save tens of millions of dollars in fraudulent claims.

Aquila's system is designed to process large data volumes -- up to 60 million records with 500 attributes each -- within 90 minutes, and can support over 200 concurrent users in a deployed instance. This makes it suited for enterprise-scale insurance and government operations with high transaction volume.

Products & Services

Aquila Fraud Detection Platform

A cloud-based AI and machine learning platform that integrates with existing claims management and adjudication systems to identify fraud patterns across workers compensation and healthcare lines. Comes with 20+ pre-built use cases specific to these lines of business.

Key Features

Predictive analytics to detect anomalies before claims are paid
Link analysis to surface hidden relationships between claimants, providers, and attorneys
IoT integration for telematics and sensor-based fraud signals
Blockchain-based operational components for audit trail integrity
Configurable dashboards and reports for SIU teams
Processes 60M+ records (500 attributes each) within 90 minutes
Supports 200+ concurrent users in enterprise deployments

Target Users: Insurance carriers, TPAs, self-insured employers in workers compensation and healthcare

Fraud Detection for Government

Fraud detection capabilities adapted for public sector benefit programs and government agencies. Helps state Employment Development Departments (EDDs) and other agencies detect fraudulent activity, surface evidence for prosecution, and reduce manual investigation hours.

Target Users: State agencies, Employment Development Departments, government benefit programs

Custom Fraud Models

Configurable fraud analytics models tailored to insurer-specific or agency-specific data, claim patterns, and risk profiles. Built on the core Aquila platform but adapted for client-specific use cases beyond the pre-built library.

Target Users: Large carriers and government agencies with proprietary data and specialized fraud patterns

SIU Investigation Support

Tooling to assist Special Investigations Unit teams in triaging and prioritizing claims for investigation. Reduces manual review burden by surfacing high-risk claims automatically and providing evidence packages for prosecutors.

Target Users: SIU investigators, claims supervisors, fraud analysts, law enforcement

At a Glance

Founded: 2017
Headquarters: Fremont, California
Employees: 51-200
Funding: Bootstrapped

Category & Focus

Category: Claims Technology
Subcategories: Fraud Detection Predictive Analytics Special Investigations Unit (SIU) Support
Insurance Verticals: Workers Compensation Health P&C Commercial
Target Customers: Carriers, TPAs, Government Agencies